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DAY CROSS STRAIGHT BILL OF LADING PLACE DATE LEVEL OF SERVICE C.O.D MONTH DAY YEAR GENERAL PRO EXPEDITED AMOUNT CURRENCY: CON JUS STICKER SPECIAL HANDLING (ADDITIONAL CHARGES APPLICABLE) HERE PRIVATE RESIDENCE PICK UP TAILGATE PICK UP TAILGATE DELIVERY 100 PRIVATE RESIDENCE DELIVERY CHEATED SERVICE TEMPERATURE CONTROL (TL Only) PALLETS BEING RETURNED TRADE SHOW PU TRADE SHOW DELIVERY RETURN ALL PALLETS IN BOND .DANGEROUS GOODS APPOINTMENT DELIVERY (Date/Time) "This shipment contains dangerous goods as set out in the attached Shipper's Declaration CONSOLIDATION (AL origin) DECONSOLIDATION (Al Dest) SHIPPER CONSIGNEE DAY & ROSS ACCT NO. TEL NO DAY & ROSS ACCOUNT NO TEL NO. SHIPPER'S NAME CONSIGNEE'S NAME PICK UP ADDRESS DELIVERY ADDRESS CITY PROV. POSTAL CODE CITY PROV. POSTAL CODE METHOD OF PAYMENT OTHER BILL TO PARTICULARS BILL TO PREPAID COLLECT CASH IN BILL TO ADDRESS ADVANCE AMOUNT CURRENCY CON U.S. ACCOUNT THIRD PARTY BILL TO NUMBER EXPIRY LVISA MC. MAX DATEDAY ROSS Sameday WORLDWIDE Email: claims@dayandrossinc.ca email: claims@sameday.ca Mailing Address: 398 Main St. Hartland N.B. E7P 1C6 TO: FAX: STANDARD FORM FOR PRESENTATION OF LOSS AND DAMAGE CLAIMS Attn: Claims Department 398 Main Street Hartland, NB E7P 1C6 Date Bill of Lading (Pro#) This claim for $ is made against the carrier named above by (Amount of Claim) (Name of Company Submitting Claim) (Address of Company Submitting Claim) Contact Name Telephone # Email: (Person submitting claim)PROV. POSTAL CODE NO OT QUOTE NO. DESCRIPTION OR SPECIAL INSTRUCTIONS Maximum liability of $2.00/LB or $4.41/KG computed on the total actual weight unless declared valuations states otherwise. Please see additional forms and conditions on our website of www.dayross.ca or call 1.866.329.7677 and request that a copy be sent to you. . OF PCS DESCRIPTION OF ARTICLES AND SPECIAL MARKS WEIGHT DECLARED DIMENSIONS CHARGES VALUATION (L x W x H) LBS KGS CDN. ]U.S. "ALL USED HOUSEHOLD GOODS AND PERSONAL EFFECTS SHIPPED AT SHIPPER'S RISK OF DAMAGE The uniform TERMS OF CARRIAGE apply to NOTICE OF CLAIM must be submitted in writing within sixty (60) The carrier's maximum liability is limited by the his BILL OF LADING (See Terms and days of delivery. (See Term and Condition No. 2) TERMS AND CONDITIONS of the Bill of Lading Condition No. 1) (See Term and Condition No. 5) SHIPPER'S PICK-UP NO. OF REF. NO DATE PCS SHIPPER'S DAY & ROSS SIGNATURE DRIVER PRINT NAME POWER NO. TRAILER NO ORIGINAL - NOT NEGOTIABLE